【罂粟摘要】脓毒血症患者不同MAP水平与30天死亡率之间的关系：一项倾向评分匹配回顾性队列研究

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脓毒血症患者不同MAP水平与30天死亡率之间的关系：一项倾向评分匹配回顾性队列研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：宋雨婷

编辑：宋雨婷

审校：曹莹

1背景

脓毒血症是由感染相关的宿主反应紊乱引起危及生命的器官功能障碍性疾病。足够的平均动脉压是组织和器官灌注的重要前提条件，贯穿脓毒血症患者的治疗，早期适当的平均动脉压与治疗的积极结果相关。因此，本研究旨在探讨脓毒血症患者早期平均动脉压水平与短期死亡率的关系。

2方法

本研究纳入重症监护医学信息数据库（MIMIC-III数据库）中所有疑似脓毒血症且在重症监护病房的首日平均动脉压≥60 mmHg的患者。将这些患者分为允许性低平均动脉压组（60-65 mmHg）和高平均动脉压组（> 65 mmHg）。采用多因素Cox回归分析，分析两组疑似脓毒血症患者MAP水平与30天、60天和100天死亡率的关系。采用倾向性评分匹配（PSM）、逆概率处理加权（IPTW)、标准化死亡比加权 (SMRW)、PA加权（PA）、重叠加权(OW)和双重稳健分析(DR)进行数据分析。

3结果

共有14031名疑似脓毒症患者纳入此次研究，其中1305名（9.3%）的首日平均动脉压为60-65 mmHg，其余12726名患者的首日平均动脉压超过65 mmHg。与允许性低平均动脉压组相比，高平均动脉压组的30天死亡风险降低（HR 0.67（95%CI 0.60–0.75;P < 0.001））。较高的平均动脉压也与60天和100天住院死亡率减少以及重症监护病房住院时间缩短有关。高平均动脉压组的患者在重症监护病房的第一天和第二天的尿量也更多。

4结论

风险调整后，脓毒血症患者初始平均动脉压高于65 mmHg与短期死亡率降低、ICU住院时间缩短和入ICU后两天内尿量增加有关。

原始文献来源：

Zhong X, Li H, Chen Q, et al. Association between different MAP levels and 30-day mortality in sepsis patients: a propensity-score-matched, retrospective cohort study. BMC Anesthesiol. 2023;23(1):116. Published 2023 Apr 6.

英文原文

Association between different MAP levels and 30-day mortality in sepsis patients: a propensity-score-matched, retrospective cohort study

Background: Sepsis is a life-threatening organ dysfunction caused by the infection-related host response disorder. Adequate mean arterial pressure is an important prerequisite of tissue and organ perfusion, which runs through the treatment of sepsis patients, and an appropriate mean arterial pressure titration in the early-stage correlates to the positive outcome of the treatment. Therefore, in the present study, we aimed to elucidate the relationship between early mean arterial pressure levels and short-term mortality in sepsis patients.

Methods: We included all suspected sepsis patients from MIMIC-III database with average mean arterial pressure ≥ 60 mmHg on the first day of intensive care unit stay. Those patients were then divided into a permissive low-mean arterial pressure group (60–65 mmHg) and a high-mean arterial pressure group (> 65 mmHg). Multivariate Cox regression analysis was conducted to analyze the relationship between MAP level and 30-day, 60-day, and 100-day mortality of suspected sepsis patients in the two groups. Propensity score matching, inverse probability of treatment weighing, standardized mortality ratio weighting, PA weighting, overlap weighting, and doubly robust analysis were used to verify our results.

Results: A total of 14,031 suspected sepsis patients were eligible for inclusion in our study, among which 1305 (9.3%) had an average first-day mean arterial pressure of 60–65 mmHg, and the remaining 12,726 patients had an average first-day mean arterial pressure of more than 65 mmHg. The risk of 30-day mortality was reduced in the high mean arterial pressure group compared with the permissive low-mean arterial pressure group (HR 0.67 (95% CI 0.60–0.75; p < 0.001)). The higher mean arterial pressure was also associated with lower 60-day and 100-day in-hospital mortality as well as with shorter duration of intensive care unit stay. Patients in the high-mean arterial pressure group also had more urine output on the first and second days of intensive care unit admission.

Conclusions: After risk adjustment, the initial mean arterial pressure of above 65 mmHg was associated with reduced short-term mortality, shorter intensive care unit stay, and higher urine volume in the first two days among patients with sepsis.

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